DOCTORSAIB

Ophtho or bust!
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I was reading the rad onc forum where our colleagues there are due for a huge pay cut (which is so not fair) according to the initial CMS report.

And I noticed ophtho is due for a pay raise of 11%? Am I reading this correctly? Are we about to catch a break from the gov't? Should I be optimistic?

1 TOTAL $ 77,744 0% 1% 0% 1%
2 ALLERGY/IMMUNOLOGY $ 171 0% 0% -2% -3%
3 ANESTHESIOLOGY $ 1,713 0% 5% 1% 6%
4 CARDIAC SURGERY $ 371 -1% -1% 3% -2%
5 CARDIOLOGY $ 7,179 0% -10% -1% -11%
6 COLON AND RECTAL SURGERY $ 129 -1% 5% 1% 5%
7 CRITICAL CARE $ 221 0% 3% 1% 3%
8 DERMATOLOGY $ 2,504 0% 2% 0% 3%
9 EMERGENCY MEDICINE $ 2,395 0% 2% 0% 2%
10 ENDOCRINOLOGY $ 370 -1% 3% 0% 3%
11 FAMILY PRACTICE $ 5,055 2% 5% 1% 8%
12 GASTROENTEROLOGY $ 1,779 -1% 1% 0% 0%
13 GENERAL PRACTICE $ 719 1% 5% 0% 6%
14 GENERAL SURGERY $ 2,213 -1% 4% 1% 4%
15 GERIATRICS $ 167 1% 6% 1% 8%
16 HAND SURGERY $ 89 -1% 4% 0% 3%
17 HEMATOLOGY/ONCOLOGY $ 1,888 0% -5% -1% -6%
18 INFECTIOUS DISEASE $ 549 -1% 4% 1% 3%
19 INTERNAL MEDICINE $ 10,061 1% 4% 1% 6%
20 INTERVENTIONAL PAIN MANAGEMENT. $ 352 -1% 7% 0% 6%
21 INTERVENTIONAL RADIOLOGY $ 227 0% -10% 0% -10%
22 NEPHROLOGY $ 1,789 0% 1% 1% 2%
23 NEUROLOGY $ 1,417 -2% 6% 0% 3%
24 NEUROSURGERY $ 586 -1% 3% 1% 2%
25 NUCLEAR MEDICINE $ 72 0% -12% -2% -13%
26 OBSTETRICS/GYNECOLOGY $ 615 0% 1% 0% 1%
27 OPHTHALMOLOGY $ 4,736 0% 11% 0% 11%
28 ORTHOPEDIC SURGERY $ 3,257 0% 4% 0% 3%
29 OTOLARNGOLOGY $ 926 -1% 3% -1% 1%
30 PATHOLOGY $ 985 0% -1% 0% 0%
31 PEDIATRICS $ 64 1% 4% 0% 4%
32 PHYSICAL MEDICINE $ 816 0% 7% 0% 7%
33 PLASTIC SURGERY $ 278 -1% 5% 1% 5%
34 PSYCHIATRY $ 1,071 0% 2% 1% 3%
35 PULMONARY DISEASE $ 1,753 -1% 3% 1% 3%
36 RADIATION ONCOLOGY $ 1,799 0% -17% -1% -19%
37 RADIOLOGY $ 5,254 0% -10% -1% -11%
38 RHEUMATOLOGY $ 494 0% 0% 0% -1%
39 THORACIC SURGERY $ 389 -1% 0% 3% 2%
40 UROLOGY $ 1,989 0% -6% 0% -7%
41 VASCULAR SURGERY $ 685 -1% -1% 0% -1%
42 AUDIOLOGIST $ 35 0% -4% -7% -10%
43 CHIROPRACTOR*** $ 700 0% 4% 1% 5%
44 CLINICAL PSYCHOLOGIST $ 533 0% -7% 0% -7%
45 CLINICAL SOCIAL WORKER $ 353 0% -6% 1% -6%
46 NURSE ANESTHETIST $ 772 0% 2% 0% 2%
47 NURSE PRACTITIONER $ 1,004 1% 5% 1% 7%
48 OPTOMETRY $ 834 1% 11% 0% 12%
49 ORAL/MAXILLOFACIAL SURGERY $ 35 -1% 3% -1% 1%
50 PHYSICAL/OCCUPATIONAL THERAPY $ 1,857 0% 10% 0% 10%
51 PHYSICIAN ASSISTANT $ 749 0% 4% 0% 5%
52 PODIATRY $ 1,656 1% 7% -1% 6%
53 DIAGNOSTIC TESTING FACILITY $ 1,044 0% -19% -5% -24%
54 INDEPENDENT LABORATORY $ 960 0% -4% -1% -5%
55 PORTABLE X-RAY SUPPLIER $ 85 0% -8% -2% -11%
 

Corn Dog

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Very interesting.

Can I kindly ask what the different columns are for? Thanks.
 
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DOCTORSAIB

DOCTORSAIB

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Very interesting.

Can I kindly ask what the different columns are for? Thanks.
I tried to locate the original PDF file but to no avail. All I know is that the last column represents change in reimbursement.

We have to lobby hard to ensure the 11% stays as is until Aug. 31st. (After that no changes will be made). As you can see, many other specialists are getting shafted and they are targeting our sexy (and long overdue) pay raise to buffer their loses!
 

cme2c

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This came from a large independent survey. Lots of time and money was spent by CMS, Congress to come up with these numbers. Basically the practice expense components of the medicare fee schedule had not been updated for quite awhile. Ophthalmology does have a lot of equipment to buy, so it makes sense. But this is not set in stone yet. AAO sent out an email today to remind everyone to contact CMS to fight for this. Don't forget that as of now there is still a global 21% cut on the books unless Congress acts.
 
Jul 22, 2009
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I am a medical student hoping to enter ophthalmology soon. How can I help with this lobbying effort?
 

Eyescan

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Ophthalmologist are getting a pay cut.

Medicare started the RBRVS study 20 years ago where they determined the effort of doing different procedures, office visits, etc. Consultations were deemed to take more effort because of increased documentation, requirement to write a letter to the family doctor, etc.

Medicare is going to stop paying for consultations 1/1/2010 and require that consultations be billed as regular office visits. They say that the reason is to punish specialists and have more money for primary care. They didn't use the word "punish" but they did mention about cutting payments to specialists.

This is unfair because Medicare's own study showed that consults take more work.

Ophthalmologists often consult other specialist and even consult family doctors to clear patients for surgery so family doctors aren't going to get their consults!

Another case of government bullying of doctors. There is a comment period to CMS which ends 8/31/09 but I have little confidence that it will make any difference even though I sent my comment.
 

cme2c

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Ophthalmologist are getting a pay cut.

Medicare started the RBRVS study 20 years ago where they determined the effort of doing different procedures, office visits, etc. Consultations were deemed to take more effort because of increased documentation, requirement to write a letter to the family doctor, etc.

Medicare is going to stop paying for consultations 1/1/2010 and require that consultations be billed as regular office visits. They say that the reason is to punish specialists and have more money for primary care. They didn't use the word "punish" but they did mention about cutting payments to specialists.

This is unfair because Medicare's own study showed that consults take more work.

Ophthalmologists often consult other specialist and even consult family doctors to clear patients for surgery so family doctors aren't going to get their consults!

Another case of government bullying of doctors. There is a comment period to CMS which ends 8/31/09 but I have little confidence that it will make any difference even though I sent my comment.
But, Ophthalmology still has the eyecodes to fall back on for now. We are affected much less than other specialties because of that. Look at the reimbursement for the eyecodes, we are blessed. The societies have done us well for now. Again, we need that new practice expense to go through.
 
OP
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DOCTORSAIB

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Bump.

The CMS report was just finalized. Rad onc got spared. Rads and cards got screwed.

Anyone know how we did?
 

cme2c

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The wording from some of the AAO/ASCRS reports was difficult, but it looks like we kept the 11% increase although it will be spread out over several years.
 
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There was an article about this today from the AMA... can't vouch for it as I don't know all the behind-the-article details, but it was interesting reading.

http://www.ama-assn.org/amednews/2009/11/16/gvl21116.htm

The "How Some Specialties Will Fare" table at the end reports a 5% increase in Medicare payments for ophthalmology.

The source for the article is:
http://www.federalregister.gov/ofrupload/ofrdata/2009-26502_pi.pdf

I think the source for the 5% figure is on page 1171 in Table 49 "CY 2010 Total Allowed Charge Impact for Work, Practice Expense, and Malpractice Changes" (partial table attached, showing column headings)
 

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The increase is likely because ophthalmology is considered by some as a form of primary care. Of course, you must also keep in mind (as mentioned by a previous poster) that consultant fees are going to be eliminated. Furthermore, OCT reimbursement will be dropping, as part of the diagnostic imaging reductions. If you are a retina specialist, like me, these changes mean you might just break even. I'll take that over the 18% cut in nuclear medicine--yowzahs!